|
HC DRSNG ACTICOAT 4X8 ANTIMICROBIAL SURGICAL
|
Facility
|
IP
|
$195.44
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901606871
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.09 |
| Max. Negotiated Rate |
$166.12 |
| Rate for Payer: Adventist Health Commercial |
$39.09
|
| Rate for Payer: Cash Price |
$87.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$136.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.18
|
| Rate for Payer: EPIC Health Plan Senior |
$78.18
|
| Rate for Payer: Galaxy Health WC |
$166.12
|
| Rate for Payer: Global Benefits Group Commercial |
$117.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$124.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.91
|
| Rate for Payer: Multiplan Commercial |
$156.35
|
| Rate for Payer: Networks By Design Commercial |
$127.04
|
| Rate for Payer: Prime Health Services Commercial |
$166.12
|
|
|
HC DRSNG ACTICOAT 4X8" FLX 3
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.93 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.54
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna of CA HMO |
$97.28
|
| Rate for Payer: Cigna of CA PPO |
$112.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$129.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$96.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$106.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$106.40
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.00
|
| Rate for Payer: United Healthcare All Other HMO |
$76.00
|
| Rate for Payer: United Healthcare HMO Rider |
$76.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.20
|
| Rate for Payer: Vantage Medical Group Senior |
$129.20
|
|
|
HC DRSNG ACTICOAT 4X8" FLX 3
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$96.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
|
|
HC DRSNG ACTICOAT 8"X16" 231304
|
Facility
|
OP
|
$318.50
|
|
|
Service Code
|
CPT A6253
|
| Hospital Charge Code |
901698100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.08 |
| Max. Negotiated Rate |
$270.73 |
| Rate for Payer: Adventist Health Commercial |
$63.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$270.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$238.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$204.38
|
| Rate for Payer: Cash Price |
$143.33
|
| Rate for Payer: Cash Price |
$143.33
|
| Rate for Payer: Cigna of CA HMO |
$203.84
|
| Rate for Payer: Cigna of CA PPO |
$235.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$270.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$270.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$270.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$222.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.40
|
| Rate for Payer: EPIC Health Plan Senior |
$127.40
|
| Rate for Payer: Galaxy Health WC |
$270.73
|
| Rate for Payer: Global Benefits Group Commercial |
$191.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$202.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$115.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$187.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$222.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$222.95
|
| Rate for Payer: Multiplan Commercial |
$254.80
|
| Rate for Payer: Networks By Design Commercial |
$207.03
|
| Rate for Payer: Prime Health Services Commercial |
$270.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$191.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$191.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.25
|
| Rate for Payer: United Healthcare All Other HMO |
$159.25
|
| Rate for Payer: United Healthcare HMO Rider |
$159.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$270.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$270.73
|
| Rate for Payer: Vantage Medical Group Senior |
$270.73
|
|
|
HC DRSNG ACTICOAT 8"X16" 231304
|
Facility
|
IP
|
$318.50
|
|
|
Service Code
|
CPT A6253
|
| Hospital Charge Code |
901698100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$270.73 |
| Rate for Payer: Adventist Health Commercial |
$63.70
|
| Rate for Payer: Cash Price |
$143.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$222.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.40
|
| Rate for Payer: EPIC Health Plan Senior |
$127.40
|
| Rate for Payer: Galaxy Health WC |
$270.73
|
| Rate for Payer: Global Benefits Group Commercial |
$191.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$202.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$187.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.44
|
| Rate for Payer: Multiplan Commercial |
$254.80
|
| Rate for Payer: Networks By Design Commercial |
$207.03
|
| Rate for Payer: Prime Health Services Commercial |
$270.73
|
|
|
HC DRSNG ALLEVYN 2 3/8" X 4 3/4"
|
Facility
|
OP
|
$11.64
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901607772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$27.67 |
| Rate for Payer: Adventist Health Commercial |
$2.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.47
|
| Rate for Payer: Cash Price |
$5.24
|
| Rate for Payer: Cash Price |
$5.24
|
| Rate for Payer: Cigna of CA HMO |
$7.45
|
| Rate for Payer: Cigna of CA PPO |
$8.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.66
|
| Rate for Payer: EPIC Health Plan Senior |
$4.66
|
| Rate for Payer: Galaxy Health WC |
$9.89
|
| Rate for Payer: Global Benefits Group Commercial |
$6.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.15
|
| Rate for Payer: Multiplan Commercial |
$9.31
|
| Rate for Payer: Networks By Design Commercial |
$7.57
|
| Rate for Payer: Prime Health Services Commercial |
$9.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.82
|
| Rate for Payer: United Healthcare All Other HMO |
$5.82
|
| Rate for Payer: United Healthcare HMO Rider |
$5.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.89
|
| Rate for Payer: Vantage Medical Group Senior |
$9.89
|
|
|
HC DRSNG ALLEVYN 2 3/8" X 4 3/4"
|
Facility
|
IP
|
$11.64
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901607772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$9.89 |
| Rate for Payer: Adventist Health Commercial |
$2.33
|
| Rate for Payer: Cash Price |
$5.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.66
|
| Rate for Payer: EPIC Health Plan Senior |
$4.66
|
| Rate for Payer: Galaxy Health WC |
$9.89
|
| Rate for Payer: Global Benefits Group Commercial |
$6.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.79
|
| Rate for Payer: Multiplan Commercial |
$9.31
|
| Rate for Payer: Networks By Design Commercial |
$7.57
|
| Rate for Payer: Prime Health Services Commercial |
$9.89
|
|
|
HC DRSNG ALLEVYN GB LITE 2" X 2"
|
Facility
|
OP
|
$11.07
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901608075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$27.67 |
| Rate for Payer: Adventist Health Commercial |
$2.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.10
|
| Rate for Payer: Cash Price |
$4.98
|
| Rate for Payer: Cash Price |
$4.98
|
| Rate for Payer: Cigna of CA HMO |
$7.08
|
| Rate for Payer: Cigna of CA PPO |
$8.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.43
|
| Rate for Payer: EPIC Health Plan Senior |
$4.43
|
| Rate for Payer: Galaxy Health WC |
$9.41
|
| Rate for Payer: Global Benefits Group Commercial |
$6.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.75
|
| Rate for Payer: Multiplan Commercial |
$8.86
|
| Rate for Payer: Networks By Design Commercial |
$7.20
|
| Rate for Payer: Prime Health Services Commercial |
$9.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.54
|
| Rate for Payer: United Healthcare All Other HMO |
$5.54
|
| Rate for Payer: United Healthcare HMO Rider |
$5.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.41
|
| Rate for Payer: Vantage Medical Group Senior |
$9.41
|
|
|
HC DRSNG ALLEVYN GB LITE 2" X 2"
|
Facility
|
IP
|
$11.07
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901608075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: Adventist Health Commercial |
$2.21
|
| Rate for Payer: Cash Price |
$4.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.43
|
| Rate for Payer: EPIC Health Plan Senior |
$4.43
|
| Rate for Payer: Galaxy Health WC |
$9.41
|
| Rate for Payer: Global Benefits Group Commercial |
$6.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.66
|
| Rate for Payer: Multiplan Commercial |
$8.86
|
| Rate for Payer: Networks By Design Commercial |
$7.20
|
| Rate for Payer: Prime Health Services Commercial |
$9.41
|
|
|
HC DRSNG ALLEVYN GB LITE 4" X 12"
|
Facility
|
OP
|
$50.51
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901608078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$45.81 |
| Rate for Payer: Adventist Health Commercial |
$10.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.41
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cigna of CA HMO |
$32.33
|
| Rate for Payer: Cigna of CA PPO |
$37.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.20
|
| Rate for Payer: EPIC Health Plan Senior |
$20.20
|
| Rate for Payer: Galaxy Health WC |
$42.93
|
| Rate for Payer: Global Benefits Group Commercial |
$30.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.36
|
| Rate for Payer: Multiplan Commercial |
$40.41
|
| Rate for Payer: Networks By Design Commercial |
$32.83
|
| Rate for Payer: Prime Health Services Commercial |
$42.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.25
|
| Rate for Payer: United Healthcare All Other HMO |
$25.25
|
| Rate for Payer: United Healthcare HMO Rider |
$25.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.93
|
| Rate for Payer: Vantage Medical Group Senior |
$42.93
|
|
|
HC DRSNG ALLEVYN GB LITE 4" X 12"
|
Facility
|
IP
|
$50.51
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901608078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$42.93 |
| Rate for Payer: Adventist Health Commercial |
$10.10
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.20
|
| Rate for Payer: EPIC Health Plan Senior |
$20.20
|
| Rate for Payer: Galaxy Health WC |
$42.93
|
| Rate for Payer: Global Benefits Group Commercial |
$30.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.12
|
| Rate for Payer: Multiplan Commercial |
$40.41
|
| Rate for Payer: Networks By Design Commercial |
$32.83
|
| Rate for Payer: Prime Health Services Commercial |
$42.93
|
|
|
HC DRSNG ALLEVYN GB LITE 4" X 8"
|
Facility
|
OP
|
$30.50
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901608076
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$45.81 |
| Rate for Payer: Adventist Health Commercial |
$6.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.57
|
| Rate for Payer: Cash Price |
$13.72
|
| Rate for Payer: Cash Price |
$13.72
|
| Rate for Payer: Cigna of CA HMO |
$19.52
|
| Rate for Payer: Cigna of CA PPO |
$22.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.20
|
| Rate for Payer: EPIC Health Plan Senior |
$12.20
|
| Rate for Payer: Galaxy Health WC |
$25.93
|
| Rate for Payer: Global Benefits Group Commercial |
$18.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.35
|
| Rate for Payer: Multiplan Commercial |
$24.40
|
| Rate for Payer: Networks By Design Commercial |
$19.82
|
| Rate for Payer: Prime Health Services Commercial |
$25.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.25
|
| Rate for Payer: United Healthcare All Other HMO |
$15.25
|
| Rate for Payer: United Healthcare HMO Rider |
$15.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$25.93
|
|
|
HC DRSNG ALLEVYN GB LITE 4" X 8"
|
Facility
|
IP
|
$30.50
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901608076
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$25.93 |
| Rate for Payer: Adventist Health Commercial |
$6.10
|
| Rate for Payer: Cash Price |
$13.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.20
|
| Rate for Payer: EPIC Health Plan Senior |
$12.20
|
| Rate for Payer: Galaxy Health WC |
$25.93
|
| Rate for Payer: Global Benefits Group Commercial |
$18.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.32
|
| Rate for Payer: Multiplan Commercial |
$24.40
|
| Rate for Payer: Networks By Design Commercial |
$19.82
|
| Rate for Payer: Prime Health Services Commercial |
$25.93
|
|
|
HC DRSNG ALLEVYN GB LITE 4" X 9"
|
Facility
|
IP
|
$38.13
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901608077
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$32.41 |
| Rate for Payer: Adventist Health Commercial |
$7.63
|
| Rate for Payer: Cash Price |
$17.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.25
|
| Rate for Payer: EPIC Health Plan Senior |
$15.25
|
| Rate for Payer: Galaxy Health WC |
$32.41
|
| Rate for Payer: Global Benefits Group Commercial |
$22.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.15
|
| Rate for Payer: Multiplan Commercial |
$30.50
|
| Rate for Payer: Networks By Design Commercial |
$24.78
|
| Rate for Payer: Prime Health Services Commercial |
$32.41
|
|
|
HC DRSNG ALLEVYN GB LITE 4" X 9"
|
Facility
|
OP
|
$38.13
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901608077
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$45.81 |
| Rate for Payer: Adventist Health Commercial |
$7.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.47
|
| Rate for Payer: Cash Price |
$17.16
|
| Rate for Payer: Cash Price |
$17.16
|
| Rate for Payer: Cigna of CA HMO |
$24.40
|
| Rate for Payer: Cigna of CA PPO |
$28.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.25
|
| Rate for Payer: EPIC Health Plan Senior |
$15.25
|
| Rate for Payer: Galaxy Health WC |
$32.41
|
| Rate for Payer: Global Benefits Group Commercial |
$22.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.69
|
| Rate for Payer: Multiplan Commercial |
$30.50
|
| Rate for Payer: Networks By Design Commercial |
$24.78
|
| Rate for Payer: Prime Health Services Commercial |
$32.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.07
|
| Rate for Payer: United Healthcare All Other HMO |
$19.07
|
| Rate for Payer: United Healthcare HMO Rider |
$19.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.41
|
| Rate for Payer: Vantage Medical Group Senior |
$32.41
|
|
|
HC DRSNG ALLEVYN GB LITE 5" X 5"
|
Facility
|
OP
|
$19.84
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901608079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$45.81 |
| Rate for Payer: Multiplan Commercial |
$15.87
|
| Rate for Payer: Networks By Design Commercial |
$12.90
|
| Rate for Payer: Adventist Health Commercial |
$3.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.73
|
| Rate for Payer: Cash Price |
$8.93
|
| Rate for Payer: Cash Price |
$8.93
|
| Rate for Payer: Cigna of CA HMO |
$12.70
|
| Rate for Payer: Cigna of CA PPO |
$14.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.94
|
| Rate for Payer: EPIC Health Plan Senior |
$7.94
|
| Rate for Payer: Galaxy Health WC |
$16.86
|
| Rate for Payer: Global Benefits Group Commercial |
$11.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.89
|
| Rate for Payer: Prime Health Services Commercial |
$16.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.92
|
| Rate for Payer: United Healthcare All Other HMO |
$9.92
|
| Rate for Payer: United Healthcare HMO Rider |
$9.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.86
|
| Rate for Payer: Vantage Medical Group Senior |
$16.86
|
|
|
HC DRSNG ALLEVYN GB LITE 5" X 5"
|
Facility
|
IP
|
$19.84
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901608079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$16.86 |
| Rate for Payer: Adventist Health Commercial |
$3.97
|
| Rate for Payer: Cash Price |
$8.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.94
|
| Rate for Payer: EPIC Health Plan Senior |
$7.94
|
| Rate for Payer: Galaxy Health WC |
$16.86
|
| Rate for Payer: Global Benefits Group Commercial |
$11.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.76
|
| Rate for Payer: Multiplan Commercial |
$15.87
|
| Rate for Payer: Networks By Design Commercial |
$12.90
|
| Rate for Payer: Prime Health Services Commercial |
$16.86
|
|
|
HC DRSNG ALLEVYN GB LITE 7" X 7"
|
Facility
|
OP
|
$42.72
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901608080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$36.31 |
| Rate for Payer: Adventist Health Commercial |
$8.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.41
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cigna of CA HMO |
$27.34
|
| Rate for Payer: Cigna of CA PPO |
$31.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.09
|
| Rate for Payer: EPIC Health Plan Senior |
$17.09
|
| Rate for Payer: Galaxy Health WC |
$36.31
|
| Rate for Payer: Global Benefits Group Commercial |
$25.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.90
|
| Rate for Payer: Multiplan Commercial |
$34.18
|
| Rate for Payer: Networks By Design Commercial |
$27.77
|
| Rate for Payer: Prime Health Services Commercial |
$36.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.36
|
| Rate for Payer: United Healthcare All Other HMO |
$21.36
|
| Rate for Payer: United Healthcare HMO Rider |
$21.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.31
|
| Rate for Payer: Vantage Medical Group Senior |
$36.31
|
|
|
HC DRSNG ALLEVYN GB LITE 7" X 7"
|
Facility
|
IP
|
$42.72
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901608080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$36.31 |
| Rate for Payer: Adventist Health Commercial |
$8.54
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.09
|
| Rate for Payer: EPIC Health Plan Senior |
$17.09
|
| Rate for Payer: Galaxy Health WC |
$36.31
|
| Rate for Payer: Global Benefits Group Commercial |
$25.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.25
|
| Rate for Payer: Multiplan Commercial |
$34.18
|
| Rate for Payer: Networks By Design Commercial |
$27.77
|
| Rate for Payer: Prime Health Services Commercial |
$36.31
|
|
|
HC DRSNG AQUACEL AG ADV .39X18"
|
Facility
|
IP
|
$83.75
|
|
| Hospital Charge Code |
901698460
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.75 |
| Max. Negotiated Rate |
$71.19 |
| Rate for Payer: Adventist Health Commercial |
$16.75
|
| Rate for Payer: Cash Price |
$37.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.50
|
| Rate for Payer: EPIC Health Plan Senior |
$33.50
|
| Rate for Payer: Galaxy Health WC |
$71.19
|
| Rate for Payer: Global Benefits Group Commercial |
$50.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.10
|
| Rate for Payer: Multiplan Commercial |
$67.00
|
| Rate for Payer: Networks By Design Commercial |
$54.44
|
| Rate for Payer: Prime Health Services Commercial |
$71.19
|
|
|
HC DRSNG AQUACEL AG ADV .39X18"
|
Facility
|
OP
|
$83.75
|
|
| Hospital Charge Code |
901698460
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.75 |
| Max. Negotiated Rate |
$71.19 |
| Rate for Payer: United Healthcare HMO Rider |
$41.88
|
| Rate for Payer: Adventist Health Commercial |
$16.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$54.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.74
|
| Rate for Payer: Cash Price |
$37.69
|
| Rate for Payer: Cigna of CA HMO |
$53.60
|
| Rate for Payer: Cigna of CA PPO |
$61.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$71.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.50
|
| Rate for Payer: EPIC Health Plan Senior |
$33.50
|
| Rate for Payer: Galaxy Health WC |
$71.19
|
| Rate for Payer: Global Benefits Group Commercial |
$50.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$58.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58.62
|
| Rate for Payer: Multiplan Commercial |
$67.00
|
| Rate for Payer: Networks By Design Commercial |
$54.44
|
| Rate for Payer: Prime Health Services Commercial |
$71.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.88
|
| Rate for Payer: United Healthcare All Other HMO |
$41.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.19
|
| Rate for Payer: Vantage Medical Group Senior |
$71.19
|
|
|
HC DRSNG AQUACEL AG HYDROFIBER W SILVER
|
Facility
|
IP
|
$1,276.13
|
|
| Hospital Charge Code |
901606395
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$255.23 |
| Max. Negotiated Rate |
$1,084.71 |
| Rate for Payer: Adventist Health Commercial |
$255.23
|
| Rate for Payer: Cash Price |
$574.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$893.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$510.45
|
| Rate for Payer: EPIC Health Plan Senior |
$510.45
|
| Rate for Payer: Galaxy Health WC |
$1,084.71
|
| Rate for Payer: Global Benefits Group Commercial |
$765.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$810.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$752.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.27
|
| Rate for Payer: Multiplan Commercial |
$1,020.90
|
| Rate for Payer: Networks By Design Commercial |
$829.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,084.71
|
|
|
HC DRSNG AQUACEL AG HYDROFIBER W SILVER
|
Facility
|
OP
|
$1,276.13
|
|
| Hospital Charge Code |
901606395
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$255.23 |
| Max. Negotiated Rate |
$1,084.71 |
| Rate for Payer: Adventist Health Commercial |
$255.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$837.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,084.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$701.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$957.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$818.89
|
| Rate for Payer: Cash Price |
$574.26
|
| Rate for Payer: Cigna of CA HMO |
$816.72
|
| Rate for Payer: Cigna of CA PPO |
$944.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,084.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,084.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,084.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$893.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$510.45
|
| Rate for Payer: EPIC Health Plan Senior |
$510.45
|
| Rate for Payer: Galaxy Health WC |
$1,084.71
|
| Rate for Payer: Global Benefits Group Commercial |
$765.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$810.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$463.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$752.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$893.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$893.29
|
| Rate for Payer: Multiplan Commercial |
$1,020.90
|
| Rate for Payer: Networks By Design Commercial |
$829.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,084.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$765.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$765.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$638.07
|
| Rate for Payer: United Healthcare All Other HMO |
$638.07
|
| Rate for Payer: United Healthcare HMO Rider |
$638.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$638.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,084.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,084.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,084.71
|
|
|
HC DRSNG AQUACEL AG SLVR 3.5X6.0"
|
Facility
|
IP
|
$196.98
|
|
| Hospital Charge Code |
901698166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$167.43 |
| Rate for Payer: Adventist Health Commercial |
$39.40
|
| Rate for Payer: Cash Price |
$88.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.79
|
| Rate for Payer: EPIC Health Plan Senior |
$78.79
|
| Rate for Payer: Galaxy Health WC |
$167.43
|
| Rate for Payer: Global Benefits Group Commercial |
$118.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.28
|
| Rate for Payer: Multiplan Commercial |
$157.58
|
| Rate for Payer: Networks By Design Commercial |
$128.04
|
| Rate for Payer: Prime Health Services Commercial |
$167.43
|
|
|
HC DRSNG AQUACEL AG SLVR 3.5X6.0"
|
Facility
|
OP
|
$196.98
|
|
| Hospital Charge Code |
901698166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$167.43 |
| Rate for Payer: Dignity Health Medi-Cal |
$167.43
|
| Rate for Payer: Adventist Health Commercial |
$39.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$129.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.40
|
| Rate for Payer: Cash Price |
$88.64
|
| Rate for Payer: Cigna of CA HMO |
$126.07
|
| Rate for Payer: Cigna of CA PPO |
$145.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$167.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.79
|
| Rate for Payer: EPIC Health Plan Senior |
$78.79
|
| Rate for Payer: Galaxy Health WC |
$167.43
|
| Rate for Payer: Global Benefits Group Commercial |
$118.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.89
|
| Rate for Payer: Multiplan Commercial |
$157.58
|
| Rate for Payer: Networks By Design Commercial |
$128.04
|
| Rate for Payer: Prime Health Services Commercial |
$167.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$118.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$118.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.49
|
| Rate for Payer: United Healthcare All Other HMO |
$98.49
|
| Rate for Payer: United Healthcare HMO Rider |
$98.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$167.43
|
| Rate for Payer: Vantage Medical Group Senior |
$167.43
|
|
